Medicare Coverage of Diabetes Care and Treatment
What It Is
Treatment and care of someone diagnosed with diabetes (also see Diabetes Supplies and Equipment)
Medicare Part B covers a variety of types of care and treatment for someone diagnosed with diabetes. These include:
Physician or other provider services. Medicare Part B covers regular chronic care monitoring by a physician or other provider, and treatment of any of the disease's symptomatic or secondary conditions.
Eye examinations. Medicare Part B covers yearly eye examinations for diabetic retinopathy and glaucoma.
Foot examination. Medicare Part B covers one foot examination every six months by a physician, podiatrist, or other licensed provider for someone who's been diagnosed with diabetic peripheral neuropathy resulting in loss of protective sensation.
Hemoglobin A1c tests. Medicare Part B covers this test, which measures blood sugar control over time.
Self-management training. Medicare Part B covers up to ten hours of initial self-management training, if prescribed by a physician, to teach patients to monitor and control their diabetes. Initial training is available to those who are first diagnosed with diabetes, who begin or switch diabetes medication, who have diabetes and have just become eligible for Medicare Part B, or who are at risk for complications as judged by a treating physician. The training includes instruction about insulin and other medication, blood sugar levels, diet, and exercise. Some group follow-up training may also be available.
Medical nutrition therapy. Medicare Part B covers medical nutrition assessment and counseling, if prescribed by a physician, given by a Medicare-certified nutritionist or dietician to help the patient manage diabetes.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for diabetes care and treatment, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for each of the above-described services, except for hemoglobin A1c tests, for which Medicare Part B pays 100 percent of the Medicare-approved amount.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.